I was recently alerted to a concerning trend in medical training in Australia which is to make trainee doctors pay for the college selection process through a cost-recovery process. With some colleges now charging over $1,000 just so a trainee can go through the process of applying for training with no guarantee of a post at the end of this.
A Situational Judgement Test (SJT) is a form of psychometric test used now in many industries to aid employers to select the best candidate for the role. Its purported benefit is that, rather than being an “off-the-shelf” test, it is specifically designed or selected to mirror the types of challenges and dilemmas an employee might be required to deal with on the job. In theory its a more direct measure of actual job related behaviour.
If an employer was to decide that they wish to use a psychometric test in a job selection process then they would normally include this in the sequence of other selection tools, generally prior to the main interview round, and organise for the potential candidates to sit this test at the employers expense.
Many of the medical colleges in Australia have made efforts of late to improve the quality of trainee selection. This includes utilising tests like the SJT. As a passionate advocate for evidence-based selection I applaud these moves. However, I was recently alerted to a concerning trend in medical training in Australia which is to make trainee doctors pay for the college selection process through a cost-recovery process. With some colleges now charging over $1,000 just so a trainee can go through the process of applying for training with no guarantee of a post at the end of this.
The Royal Australian and New Zealand College of Ophthalmologists now charges a non-refundable fee of $1200 AUD. But does not indicate in its official information what this fee is for. The Royal Australian and New Zealand College of Obstetricians and Gynaecolgists advises that “all applicants will be required to pay a non-refundable application fee in order to apply for a training position” of $570 and that “applicants shortlisted for interview will be required to pay a non-refundable interview fee” of $880. The Royal Australasian College of Surgeons applies a “processing fee” for trainee applications of $880. The Australian and New Zealand College of Anaesthetists have an application fee of $740.
But not every college charges an application fee. Some, including the Royal Australian and New Zealand College of Psychiatrists and the Royal Australian and New Zealand College of Radiologists only choose to charge a registration fee if trainees are actually selected into training.
My view is that a small application fee is perhaps reasonable in some cases, particularly high demand specialties, in order to discourage excessive and frivolous applications. But efforts to make trainee doctors pay for the actual cost of the process of selection are unwise and unfair. And particularly risk discriminating against many members of the medical community who may not be able to afford such significant fees for a host of reasons.
What About Specialist Assessments?
And the issue does not stop with the matter of trainee doctor applications. If you are an international medical graduate and specialist be prepared to part with tens of thousands of dollars in some cases to go through the full specialist assessment & recognition process.
What Are The Issues?
There are a number of issues here.
First, is the need for colleges to have some form of selection into training that seeks out the best candidates, but is also transparent fair and encourages diversity.
Second, is the cost of carrying out this process which would include things like the costs of college professional staff time, the lost opportunity cost of the time spent by college Fellows involved in the selection process, the cost of developing the selection process (SJTs are not cheap to develop), as well as potentially travel and accommodation and venue hire costs, IT costs and other costs. So significant costs.
Third, is the question whether colleges should behave the same as employers in this situation or be allowed to act differently because they are not employers? Which then draws in the issue that colleges act in a legal monopoly situation in this country. In that, through their membership, they control who is permitted to provide certain services, thus making membership of a college particularly valuable.
Fourth, is the acknowledgement that costs do inevitably need to be borne by someone or something.
To the above I will also add the question. Why do some colleges choose not to apply a selection fee or cost-recover when some do?
Are Colleges Really That Different to Employers of Trainees?
I don't buy the argument that colleges are not employers (and therefore don't have to act like employers). Colleges still operate as businesses to fulfill the needs of their members. Colleges are in fact in the business of making Fellows. They just don't have to deal with competition in an open market, like most other employers.
If you lived in a small rural town and the only supermarket started charging application fees to young members of the community interested in working at the supermarket. Would that be a fair and ethical situation?
Trainee doctors are generally in a better financial position than a supermarket worker and can arguably afford a moderate application fee. But relative remuneration for trainee doctors has declined of late with significant reductions in hospital over time. And I have discussed on this blog before how specialist doctors are able to make significantly more remuneration than the trainee doctors who support them.
And it is not 100% the case that a trainee doctor can afford the significant costs required to get into a training scheme and remain on it. These costs start with paying off around $50,000 of university HELP debt or perhaps servicing a loan of $250,000 if you pay up front fees. They can then include paying tens of thousands of dollars for a Masters Course or several thousands of dollars for various short courses to improve your selectability prospects with a college. Then there is whatever application or interview fee that is posed by the college. And once you are into training around 2 or 3 thousand dollars per year of training fees, plus various examination and assignment marking fees that generally add a few more thousand dollars per year to the cost.
Why Fairness and Transparency Is Not Enough
If you have been privileged enough to grow up in a middle or higher income family with financial support, free room and board, and you are working as a resident now then you are probably managing these costs okay.
But imagine if you are the first person from your family and community ever to do medicine. Imagine if you and your family had to scrap and sacrifice to get you through medical school. Imagine if you were having to work more than part-time just to make it through medical school. You are now a resident but your debt situation, your financial security and discretionary capacity is likely to still be far worse than the example of the doctor above.
Imagine adding to this that you are a single parent doctor who needs to work part-time. Yes these doctors do exist in resident land and they are some of the most courageous doctors you will ever meet.
You can perhaps see now why just having a fair and transparent selection process with a fee of over $1000 is not OK. As it actually can serve as a real barrier to some candidates. Fairness and transparency is not enough in candidate selection as these principles on their own do not encompass the reality that not every candidate comes to the selection process on the same level footing.
The Privilege of Fellowship
The day one becomes a Fellow of a College, as I have, is truly a pivotal day. Not just in ones career but also ones life. It opens you up to all manner of freedoms and opportunities that you just don't get if you only have general registration. Its a position of privilege that society has elected, through the activities of Colleges, to give to you and (depending on the college) a few other hundred or thousand other doctors.
Most Fellows of colleges have and continue to respect this privilege. They do this in many ways. One of these is to pay college fees to pay for college staff and resources and another is to contribute on a voluntary basis to the work of the college. Traditionally, this is how the majority of the cost of performing the activity of selection into training has been borne in colleges.
I would argue that this should for the most part remain the cases. Colleges cannot exist without trainees. Selection into training is a business cost for colleges.
As to why some colleges choose not to have an application fee. I suspect in some cases it is because these colleges strongly feel that they need more members and do not want to impose unecessary barriers.